Claimant sought compensation from employer for the surgery. Employer
denied the claim, and the Administrative Law Judge (ALJ) upheld the denial, concluding
that claimant had failed to meet his burden to show a sufficient connection between his
workplace injury and the medical services that he received. The ALJ also suggested that
claimant had not met his burden to show an on-the-job injury in the first instance. The
Board adopted the ALJ's order. Claimant assigns error to the Board's determination that
he is not entitled to compensation, arguing that the Board's holding is not supported by
substantial evidence and that the Board erred in not awarding compensation for the
diagnostic medical services that he received

Two statutes bear on the compensability of the medical services provided to
claimant. First, ORS 656.005(7)(a) defines "compensable injury" and addresses the
compensability of preexisting conditions:

"A 'compensable injury' is an accidental injury * * * arising out of
and in the course of employment requiring medical services or resulting in
disability or death; an injury is accidental if the result is an accident,
whether or not due to accidental means, if it is established by medical
evidence supported by objective findings, subject to the following
limitations:

"* * * * *

"(B) If an otherwise compensable injury combines at any time with a
preexisting condition to cause or prolong disability or a need for treatment,
the combined condition is compensable only if, so long as and to the extent
that the otherwise compensable injury is the major contributing cause of the
disability of the combined condition or the major contributing cause of the
need for treatment of the combined condition."

In SAIF v. Nehl, 149 Or App 309, 312, 942 P2d 859 (1997), rev den 326 Or 389 (1998),
we interpreted ORS 656.005(7)(a)(B) to require the factfinder to weigh the "extent of
claimant's preexisting condition * * * against the extent of his on-the-job injury in
determining which of the two is the primary cause of his need for treatment of the
combined condition." We further clarified that "a claimant needs to establish more than
the fact that a work injury precipitates a claimant's need for treatment in order to establish
the compensability of his combined condition." Id. at 313 (citations omitted; emphasis in
original).

ORS 656.245 addresses the compensability of medical services. It provides
in part:

"(1)(a) For every compensable injury, the insurer or the self-insured
employer shall cause to be provided medical services for conditions caused
in material part by the injury for such period as the nature of the injury or
the process of the recovery requires * * *. In addition, for consequential
and combined conditions described in ORS 656.005(7), the insurer or the
self-insured employer shall cause to be provided only those medical
services directed to medical conditions caused in major part by the injury."

Under ORS 656.005(7)(a), a claimant has the burden to show that the claimant suffered
an accidental injury at work that required medical services or resulted in disability.
Additionally, a claimant who has a preexisting condition must also show that the
"compensable injury [was] the major contributing cause of the disability of the combined
condition or the major contributing cause of the need for treatment of the combined
condition." ORS 656.005(7)(a)(B). Finally, under ORS 656.245(1)(a), the claimant must
show that the medical expenses he seeks to recover were directed to a medical condition
"caused in major part" by the compensable injury.

After examining the record, we conclude that the Board's findings that
claimant did not meet those burdens are supported by substantial evidence. Jacobson
discovered evidence of a preexisting condition during surgery. The evidence is
conflicting as to whether claimant's workplace incident or his preexisting condition was
the primary cause of his disability and need for treatment. While claimant did allege that
he felt extreme pain in his arm during and immediately after the workplace incident,
Jacobson, who performed the surgery, could find no evidence of a recent injury to
claimant's arm. Moreover, the record does not disclose whether some of claimant's other
symptoms, such as ecchymosis and the dent in his arm, were preexisting or arose only
after the workplace incident. Claimant had the burden to show that the workplace
incident was the primary cause of his need for the medical services for which he seeks
compensation. The Board could have reasonably relied on Jacobson's report in
concluding that claimant had not met that burden. As such, its denial is supported by
substantial evidence.

Claimant nonetheless argues, based on our decision in Brooks v. D & R
Timber, 55 Or App 688, 639 P2d 700 (1982), that the aborted surgery to repair the biceps
tendon is a compensable diagnostic procedure, notwithstanding the fact that the surgery
revealed a noncompensable preexisting condition. Claimant misreads Brooks. In Brooks,
the claimant had sustained an injury when a choker hook struck his left knee. The
claimant's doctor suspected that the injury may have caused a tear in the meniscus of the
knee. The doctor performed an arthroscopy on the claimant's knee to determine the
nature of his injury. Instead of a torn meniscus, the surgery revealed a synovial plica, or a
fold in the membrane that lines the knee joint. The claimant's doctor was uncertain as to
whether the workplace injury caused the synovial plica but concluded that it was probably
idiopathic. After the conclusion of the arthroscopy, the doctor made a separate incision to
repair the folded membrane. The ALJ awarded compensation for the entire surgery, but
the Board reversed, concluding that, while the claimant had sustained a compensable
injury, the surgery was not compensable. We reversed in part, holding that the
arthroscopy was compensable, because the claimant had established that the blow to his
"knee directly resulted in the need for exploratory surgery," but that the surgery to repair
the synovial plica was not. Brooks, 55 Or App at 692. See also Counts v. International
Paper Co., 146 Or App 768, 770, 934 P2d 526 (1997).

This case differs from Brooks in several important respects. First, whether
claimant sustained an on-the-job injury is itself subject to reasonable dispute in this case,
whereas in Brooks, at least at the appellate level, it was undisputed that the claimant had
suffered such an injury. Brooks, 55 Or App at 691. Moreover, in Brooks, the claimant
had shown that his injury directly resulted in his need for exploratory surgery. Because
we have upheld the Board's determination that claimant did not establish that his
workplace incident was the primary cause of his need for medical services, Brooks is of
little assistance to claimant. Finally and most importantly, the arthroscopy at issue in
Brooks was diagnostic in nature. In contrast, in this case, the stated purpose of the
surgery was not to diagnose but rather to repair an acute rupture of the tendon. When the
doctor performed the surgery, he realized that the rupture was preexisting and could not
be repaired. He then proceeded to explore the extent of the preexisting injury. Based on
that evidence, it was reasonable for the Board to conclude that the services provided to
claimant were not sufficiently related to his workplace incident to entitle him to
compensation under Brooks.